七氟醚和异丙酚对骨科手术患者止血带诱发肢体缺血再灌注损伤影响的比较  

Comparison of effects of sevoflurane versus propofol on tourniquet-induced lower extremity ischemia-reperfusion

作　　者：王宇[1] 崔宇[1] 刘斌[1] 

机构地区：[1]四川大学华西医院麻醉科,成都市610041

出　　处：《中华麻醉学杂志》2012年第10期1189-1191,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较七氟醚和异丙酚对骨科手术患者止血带诱发肢体缺血再灌注损伤的影响。方法择期行膝关节韧带修复术患者54例，性别不限，年龄18～64岁，体重44～85kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为3组（n=18）：对照组（c组）、异丙酚组（P组）和七氟醚组（S组）。行腰丛联合坐骨神经阻滞后，P组静脉注射异丙酚2～4mg／kg麻醉诱导，并置人喉罩，术中静脉输注异丙酚2～4mg·-1·h-1维持麻醉。s组吸入8％七氟醚麻醉诱导，并置人喉罩，术中吸入2％七氟醚维持麻醉。异丙酚或七氟醚给药15-20min时，C组于相应时点，应用止血带，充气压力为300mmHg，术毕时放气。术后口服美洛昔康或肌肉注射哌替啶镇痛，维持VAS评分〈3分。分别于入室后（r111）和止血带放气后30min（L）时采集血样，测定血浆MDA和TNF．a浓度，计算其增长率。术后记录止血带相关不良事件的发生情况和术后24h内镇痛药用量。结果患者均未见止血带相关不良事件发生。与c组比较，P组和s组T2时血浆MDA和TNF．d浓度及其增长率降低（P〈0．05）；与P组比较，s组血浆MDA和TNF—a浓度及其增长率差异无统计学意义（P〉0．05）；与L时比较，P组和s组L时血浆MDA和TNF．a浓度差异无统计学意义（P〉0．05），c组明显升高（P〈0．05）；3组患者术后24h内镇痛药用量比较差异均无统计学意义（P〉0．05）。结论七氟醚和异丙酚均可减轻骨科手术患者止血带诱发下肢缺血再灌注损伤，其效果无差异。Objective To compare the effects of sevoflurane versus propofol on a tourniquet-induced lower extremity ischemia-reperfusion （I/R） injury in patients undergoing orthopedic operation. Methods Fifty-four ASA Ⅰ or Ⅱ patients, aged 18-64 yr, weighing 44-85 kg, scheduled for elective orthopedic operation, were randomly assigned into 3 groups （n = 18 each） ： control group （group C）, propofol group （group P） and sevoflurane group （group S）. After lumbar plexus-sciatic nerve block, the laryngeal mask airway insertion was facilitated with propofol 2-4 mg/kg and anesthesia was maintained with infusion of propofol at 2-4 mg. kg- 1. h- 1 during operation in group P. In group S, 8 % sevoflurane was inhaled, the laryngeal mask airway was inserted and anesthesia was maintained with inhalation of 2% sevoflurane during operation. A tourniquet was applied and inflated （300 mm Hg） during 15-20 rain after administration of propofol or sevoflurane in groups P and S, and a tourniquet was also applied at the same time point in group C. The tourniquet was released at the end of operation. Postoperative analgesia was performed with oral meloxicam or intramuscular pethidine and VAS score was maintained 〈 3. Blood samples were taken after admission to the operating room （TE ） and 30 min after tourniquet release （T2 ） to determine the plasma concentrations of MDA and TNF-a. The changing rate of MDA and TNF-a concentrations was calculated. The tourniquet-related adverse events and amount of analgesics consumed within 24 h after operation wererecorded. Results No tourniquet-related adverse events occurred in all the patients. Compared with group C, the plasma concentrations of MDA and TNF-a and changing rate were significantly decreased at T2 in groups P and S （P 〈 0.05）. There were no significant differences in the plasma concentrations of MDA and TNF-a and changing rate between group S and group P （ P 〉 0.05）. Compared with the baseline value at Tl , no significant change was found in the

关 键 词：麻醉药 吸人 二异丙酚 止血带 再灌注损伤 下肢 

分 类 号：R614[医药卫生—麻醉学]